Kistein Monkhouse: Humanity in Healthcare

Join us as we welcome Kistein Monkhouse the CEO and Founder of Patient Orater -- a platform that uses storytelling to improve patient experience and population health. Also a filmmaker, Kistein discusses her documentary “Humanizing Healthcare.”

Transcript

Introduction: 

Welcome to humanizing tech. We interview people to dig below the surface of their achievements and challenges showcasing the story behind the story. We believe that focusing on the person and humanizing their lived experiences will help us shape the future of tech.

Kiva is an international nonprofit working to expand financial access to help underserved communities thrive. 100% of every dollar you lend on Kiva goes to funding loans. By lending as little as $25 you can be part of the solution and make a real difference in someone's life. More than 80% of the borrowers Kiva serves around the world are women. Learn more at kiva.org.

Anusha Neelam: Hi everyone. Before we get started, we want to acknowledge the ground we're all on wherever we're tuning in from PDXWIT has events all over Portland, Oregon, and beyond. And we want to pause to acknowledge the history of the area and work towards decolonization of the tech industry. Portland rests on traditional village sites of the Multnomah, Cathlamet, Clackamas Chinook, Tualatin, Calapooya, Molalla, and many other tribes who made their homes along the Columbia river. If you’d like to learn more about PDXWIT’s action related to land acknowledgement as well as our newest initiative Native Americans in tech, please visit our website.

Welcome back to another episode of Humanizing Tech Innovators, everybody. This is a new Anusha, she/her. Unfortunately, Ochuko could not make it today because she is hard at work on her thesis. So we sent her all of our positive vibes and wish her good luck, but I am super stoked for this innovator segment, because for those of you who've tuned in before we generally highlight our innovators and share their backstory and have some conversation around it. But today we have our first guest, so I'm super excited to talk with her and highlight her achievements. So without further ado, welcome Kistein Monkhouse. Thank you for joining us today.

Kistein Monkhouse: Thank you so very much for having me Anusha I am so honored to be here.

AN: Of course. Yeah. Thank you. Thank you for joining us. We are super excited to have this conversation with you. Christine is the CEO and founder of patient orator, which is a platform that uses storytelling to improve patient experience and population health. So Kistein, you are doing some really incredible work. Can you share a little bit about the beginnings of your career and about the path that led you towards the work that you're doing today?

KM: Sure. So my background is specifically in working in healthcare and direct care positions. I worked as a home health aid, a nursing assistant, and a health care coordinator. All of those roles really allowed me to gain an insight into the healthcare industry. Once I left the home health setting, I became aware of the industrialization of the healthcare system. In home care where I was more focused on that patient specifically that I was caring for and the team around them and managing that team. Once I entered into a physical building of let's say a nursing home, for example, seeing just how people were treated as numbers, as opposed to human bodies and being able to see how basically we don't care for human beings in these settings was really eye opening.

It was the first time that I really wanted to make a difference, but I should've prefaced that with the fact that my degree is in public administration and public health. Once I transitioned from a nursing home set into the local emergency room setting that I worked at, there was a different set of issues that I became aware of. And that was really high hospital readmission rates. More so about the fact that black and brown communities were predisposed to certain health conditions. And I kind of questioned that, and questioned it thoroughly, as to why it was that these populations in specific were being readmitted a week or so after being discharged from the setting and kind of opening my eyes to see, and that this is deeply rooted in political social and economical issues that needs to be resolved in order for us to really start treating people as human beings.

AN: Yeah, so it really sounds like you were on the front lines and you were witnessing these injustices firsthand from the experiences that you had through the different roles in, in healthcare. So while you were navigating these different roles and different aspects of healthcare, what are some of the biggest lessons you learned throughout this journey?

KM: Sure, as a young careerist, I wanted to be in healthcare forever and I wanted to actually be in that healthcare hospital set in and wanting to be an administrator. There were a few things that were happening where morally I felt conflicted about what I was witnessing in terms of patients not being treated as human beings and hearing from thousands and thousands of patients within the New York city area that their voices were not being validated. Their voices were not being heard. And then I had these deep dive conversation as the nurses aid. I had plenty of time, unlike other people that were part of the clinical team. I had time, which I would sit at the bedside with patients and listen to what they were saying. And again, going back to what I mentioned earlier, being able to tie some of the issues that patients were facing outside of the walls of the hospital, like for example, a patient may be at, I may be at bedside listening to a story and what I'm hearing in that story is that that patient has no support system at home. So that was not being captured from the clinical team. As the person who was on the delivery end and I really wanted to make a difference within that system and felt stifled because my management team really didn't validate me as someone who had the potential to grow within that organization. 

I remember this distinct conversation that went a little like this. So Kistein, "where do you see yourself in five years?" And I said, "in a position like yours", and I think that that was taken as a threat, more so than an opportunity to help me grow as an individual because I, again, I really wanted to grow up at that specific organization. Rather than providing me with the tools to grow and advance in my career pathway, I was met with this glass ceiling. Although I had this bachelor's degree, I was overly qualified for all of the positions that I was applying for, clearly enthusiastic about this field and this work that I was doing, love the patients that were coming in eager to grow. Yet, the opportunities were not there. So those are some of the big things, barriers that I experienced, and it pushed me into entrepreneurship. Of course, there was another role that played a bigger role as to why I took this path into the entrepreneurial path that I took.

AN: Hmm. And so when you are coming across all of those different roadblocks and having those challenges your perspective being heard, how did you overcome that? How did you drive forward even when you were facing those challenges and roadblocks along the way?

KM: I don't think I overcame it because I was pushed into entrepreneurship. I transitioned into a care coordination role, which meant that I was responsible for coordinating the care for patients, vulnerable patients, so to speak. People that had drug issues and housing insecurity. And when I was sitting across from a white woman who was the same age as I was, and providing her or connected her to the care that she needed, I really saw myself as someone who could have been on the other side of that table and all of the frictions that I previously encountered as an individual and kind of questioning the ethical makeup of the healthcare delivery system. I got to this point where I knew I needed to do something different. Because I was not being heard by the industry, I didn't feel as though the people I was providing care was fulfilling. Okay, so we're just going to provide them with connecting them to their doctor right now and right here. But what about the rest? Like this was someone who wanted to pursue an education, but she couldn't pursue an education because she didn't couldn't have financial aid because if she had financial aid, she would lose her housing. And that to me didn't make any sense. And that's how I kind of said, I want to kind of amplify the voices of these people, meaning people that I've had these conversations with over the years, but they were kind of stagnant in this healthcare setting. No one were really hearing these stories. And I felt like it was important to talk about healthcare disparities in a public way.

I purchased the video camera and started traveling around New York City and collecting these stories, meeting with policy makers as well. I kind of really wanted to bring the dialogue of healthcare and inequities to the forefront. But really didn't have the know it all or just the right approach of how to do it because the mission really was to tell these stories and make sure that these voices are heard. Along the way I got sick and that opened a whole new ball game of where we could potentially make a difference as an organization as patient orator. 

AN: That's amazing. Yeah and I definitely want to get into talking about patient orator here a little bit later in the segment. But I do want to talk to you a little bit about purchasing a video camera and just going around and doing some filming on your own. Is that what led to the documentary Humanizing Healthcare that you ended up filming? I know that it had won an award as well. I briefly watched it myself, but I would love to hear a little bit about how you got the idea. It sounds like you got this idea from a lot of the work that you had done previously. How did you go about documenting these stories and what was that experience like?

KM: Again, it was being at the bedside. I credit so much of my insights and so much of my journey to that. I think that if I was someone who didn't speak with patients directly, I wouldn't be moved to do the things that I've done in some ways I feel guided. There's a whole other conversation, but when I look back upon my journey and kind of see the steps that I've taken in those moments, they were really me being frustrated with a system that didn't listen. Me purchasing that camera, me incorporating patient orator and the organization, even though I didn't know what I was going to do. I just felt moved to kind of tell these stories because I was frustrated again with the system. I just really wanted to tell the stories of people from healthcare lens.

It started in New York City where I was just talking to folks about their experience with hospital systems. And what I was hearing was that it was expensive and that people were not being treated humanely. That kind of spread to several other states. It's the same narrative across the board. Folks, their parents or elderly folks not getting the help that they need to really thrive in their health. Whether it was Maryland or New York City or New Mexico, it was the same story that was being told by different folks. It didn't matter what the color of their skin was. It didn't matter what the income was across socioeconomic status was this narrative of, we want to be heard, we want to be treated as human beings. We want healthcare to this affordable. And I saw an opportunity there to tell a compelling story, put together humanizing healthcare, which is really where we need to move towards. That's how that came about. Like, you know, just all of these stories come into this, this put package in all of these stories in a way that would tell the story of the American people and what is lacking in healthcare, which is humanism.

AN: Yeah. I know that when I watched it, I really appreciated all of the multiple perspectives that were included in that documentary. How long did it take you to film it?

KM: I think it was over the course of two or three years. I started filming in late 2017, which is about the time when I incorporated and just began filming these stories. It was published in 2020 and won his first award immediately after, so I think it was quite a few years of filming, which was completely funded by myself to be transparent. Meanwhile, I think I was also pushing for patient orator, really making a difference. So it was a combination of capturing stories, but in also trying to move the needle in another way. True tech.

AN: Yeah. Is there a story from all the stories that you were hearing that still stands out to you today?

KM: Yeah, so I can't remember her name, but it was this woman that I met in Detroit. Again, I don't know if listeners can tell, but I'm someone who's really compelled-I think this word human just stands out to me as something that is necessary in our society. Again, a lot of the people I spoke with there, they're not all, African-Americans not all black, that some folks are light folks that are dirt poor and have no outlet. And one of the stories that stood out to me in specific was this woman that I met in Detroit, who shared that she had lost her left died because she didn't have health insurance. She had kidney failures because she had no health insurance. And I think listening to stories like that compels me to continue to do the work that I'm doing, because while it might not make sense from a venture capitalist standpoint, which it should. It makes sense to me that we should be doing more as individuals and as a society and as organizations to kind of move healthcare in a way that it's available to everyone. And until we're there until we can treat people equally, we're still going in the circle of treating people in silos based on their income and their class.

AN: Yeah, absolutely. So it sounds like after you wrapped up filming on this documentary, that's when you started working on patient orator. So how did you forge ahead with that idea after the documentary was wrapped up?

KM: So, I was actually doing both simultaneously. Kind of learning about the tech industry and how it works. I did a lot of self investment into reading, taking as many courses, and an incubator to learn how health tech works. Very early on, when I began filming humanizing healthcare, I had pitched the idea for a mobile health application, which would do exactly what the patient orator app does. I remember at the end of that conversation, I'd run up to someone and said, what did you take away from that? And they didn't know what food insecurity was. And that was very eye opening because it kind of made me aware of the work that I would have to do from an educational standpoint. If people are unaware that there's people that are going to bed hungry at night, because they don't have food, they don't have access to fresh fruits and vegetable. And that has a trickle down effect of how it impacts individual health, but more so on a larger scale, the entire population and what that does from a disparity standpoint.

AN: Yeah, wow. And it sounds like you were able to hone in on this need that you were seeing based off of these discrepancies and discrimination in the health care system. Can you tell us a little bit more about the specifics of what the app does?

KM: Sure, so before we share what the app does. I should share my story. While I was traveling across the country, one of the things that was happening was I realized that I became increasingly sicker than usual. So, I have found myself hunched over in the driver's seat of my car with severe chronic pain. And it was that moment that I took out my phone and started Googling about chronic pelvic pain centers near where I was. I realized in that moment that it wasn't that specific incident, that it was something that was ongoing. And I share my story very publicly because, just in case there are women that are maybe listening or anyone who may be listening that may have these episodes of illnesses and question the validity of those illnesses, because they're being told that these things don't exist.

So for me, my first episode landed me in the emergency room. I was discharged, no pain medication to manage my symptoms, and that led to a series of different hospital visits. It really took that seventh doctor to actually listen to me and say, Kistein, this is not normal. I see this very often, but that took a lot of self-advocacy where I had to literally Google when I was in a crisis. So I kind of had this moment, this light bulb moment in that instance where, you know, I was in this space and I realized that I was seen by all of these different doctors, going back to my experience from very early on where I was hearing patients, voices for not being validated and number two, the care coordination role that I had previously had in seeing how difficult it was for underserved people to connect to those resources.

And that's when I'm like, okay, so we're going to build a technology that helps to empower the narratives of people. How the application works is rather than a patient walking into a healthcare setting and being asked a few questions about why they are there from a clinical standpoint. We've created a mobile health app, which is HIPAA compliant to help patients document changes in their health related to their clinical needs, their care preferences, and also their social determinants of health. So being able to identify what social needs they may have. It's important for me to say that as a patient myself, one of the things that happens as a black woman is this factor of distress. And this is one of the things that the application seeks to solve, because if I'm a patient walking into a healthcare setting and already know that I'm being stereotyped fear sets in, and that hinders my ability to tell my story in a way that the clinician can treat me appropriately or be the clinician not treating me fairly because of the fact that they're seeing a black woman who seem or presents as a healthy individual and not really listening to the words that are coming out of my mouth.

And so this is what the application does. It captures the narrative of the patient in a clerical use of way in which a patient can then share their story electronically with their care team, or sharing your story in person with any provider. And that provider can then treat them as a whole person, both from a clinical standpoint, but also from a social determinants of health standpoint.

AN: Wow, that's amazing. I know that there are parts of that, that I can really relate to as well. And in communities that I'm a part of, I hear a lot about, some of these stories. It's very similar to stories to the ones that you're sharing right now. So, that just sounds like a really useful tool to have. So, what's next for you and patient orator? Can you share a little bit about what's ahead?

KM: Yeah, what you really want to make a difference in the lives of underserved people across the nation. As a woman entrepreneur, there's a disadvantage there, which you know, a woman and a woman of color are funded less from a venture capital standpoint. But I'm very encouraged based on the fact that patients want the application. They want to be able to store their stories and they want to be able to be heard. And that is the most important thing about what we're doing. So for us, from a business standpoint, the next step is really clinically validating within healthcare settings that this application is not only useful for the patient, but also for the provider. Again, going back to that piece that I mentioned before, where the data that we're collected is really to help that clinician make the informed decision about the clinical needs of that patient without stereotype, without distrust. Then also be able to point that patient to the care coordination that they may need outside of the clinical setting. So there are a multitude of things that we're working on, but the most important thing right now for us next is the clinically validated. So we're actively seeking for a pilot program that will help us to test our application within the healthcare or clinical setting.

AN: That's amazing. Do you have any suggestions for our listeners on how they can be better advocates for themselves? Whether it's in healthcare or beyond?

KM: To be completely transparent, my mission or the work of patient orator is really centered around this mission of amplifying voices. And you know, I'm a black woman, there's a lot of disadvantages that I have as a black person in society, but I do everything that I can to ensure that people who are less fortunate than I am are being heard. And I'm just this one person. But I think that my point is that regardless of who you are, what your socioeconomic status might be, use your voice to help empower people who may be less fortunate than you are. In recent day and time, we hear a lot about healthcare disparities and health inequities because of COVID-19. These issues existed long before that. And I will say that if you look at the slave trade, for example, people were being moved from one part of the world into another part of the world as property in, in inhumane conditions.

And we translate it like moving beyond that even women were viewed as properties of their husbands. They had no voice politically or economically, they fought for those rights, but yet here we are in our society still needing to fight against systemic injustices. And that takes a village. It doesn't take only black people or white people. It really truly takes everyone coming together, regardless of whether it's the healthcare industry or other industries, and really using their privileges at the point of the table that they're sitting in. So whether it means that you're someone who has the leverage to hire people of color and are people of marginalized identities, make that hire. If you're a provider and you're seeing patients come in from across socioeconomic status, treat that patient as a human being. And I think that's my message really, right? Because at the end of the day, when my time here on this earth has gone, my work is really, or my intention is really to leave this world in a better place than I found it. And that means moving the needle, moving the dialogue, even if it's just the dialogue. I know we're using tech, but even if you can use your voice to kind of make sure that other people are being heard, I think that's the most important thing.

AN: That's a really powerful message. I can't tell you how much I appreciate your, your transparency around that Kistein, and I feel like everything that we talked about today, I feel like it probably hits home for a lot of us, especially as we find ourselves amidst a public health crisis. So thank you for sharing your story with us today, your journey and how you got there. As we close out our segment, are there any takeaways that you'd like to share with our listeners?

KM: Sure. I think folks can learn more about our work at http://patientorder.com. We're also in social media, you can get a lot of glimpse into the stories that we tell, or the stories that I've captured across the many years that I've been doing this work. But again, going back to owning your voice. Regardless of how you may think that your voice has no power, but trust me, I'm someone who used to be a fly on like a fly on the wall, very quiet and also fearful because of the injustices that I was witnessing around me. I think use your voice, learn about the work that we're doing. Look at other organizations and the work that they're doing, and let's help them make this world a better place. I can't really ask for much more.

AN: Thank you. Thank you so much Kistein. We'll add those links to your documentary and to your website, so our listeners can check it out.

KM: Thank you so very much for having me, it's been such a pleasure, like I mentioned before, I appreciate the invite and the opportunity to be amplified in this way. And, thank you.

AN: Also shout out to our amazing podcast team who makes this all possible and to our listeners. Thanks for tuning in, and we'll catch you on the next episode of innovators.